Advice

Specialist commentator comments

Specialist commentator comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Two of 3 specialist commentators were aware of the technology. One has used CytoSorb therapy about 4 to 5 times a year over the past few years.

Level of innovation

One specialist commentator felt that CytoSorb therapy was reasonably innovative, noting that previous attempts to remove or block cytokines have not been very successful. Another noted that CytoSorb therapy is based on well-known principles of haemoadsorption but that the design and components of CytoSorb are original. The specialist commentators believed that some training would be needed to use this technology.

Potential patient impact

Two of the commentators noted that the current evidence does not show that using CytoSorb therapy results in any improvements in outcomes, such as mortality. They felt that the technology was promising but further studies are needed. One noted the need for evidence to show the impact on outcomes, such as length of stay in the intensive therapy unit, and the need for vasopressors or renal replacement therapy. One commentator felt that people with severe sepsis may particularly benefit from this therapy, especially those needing high doses of vasopressor drugs to maintain adequate organ perfusion. They pointed out that it is still unclear whether removing cytokines can affect mortality and outcomes in a beneficial way, although they felt it was clear that it can reduce the dose of vasopressor drugs needed, which is beneficial because these drugs can have harmful effects. The commentator noted that the optimal length of treatment with CytoSorb therapy is still unknown and further research is needed to determine this.

Potential system impact

One specialist commentator stated that any potential effect on NHS services would be specific to critical care. Two commentators felt that there would not be any need for changes in facilities or infrastructure if CytoSorb therapy was adopted.

All 3 commentators stated that the cost of the device would be the only impact on services, 1 of whom noted that the costs would be significant if CytoSorb therapy was used for several days. All of the commentators found it difficult to identify potential cost savings associated with using CytoSorb therapy, because there is no clear evidence to show where savings could be made. However, 1 commentator thought that savings might be made if CytoSorb reduced length of stay and another believed that savings could result from reducing the use of vasopressor drugs.

General comments

One specialist commentator believed the technology would be used in a small and specialised service for people with significantly elevated cytokine levels (particularly IL‑6) but that it is unlikely to be routinely used.